Mothers' intentions to support children's physical activity related to attention and implicit agreement with advertisements.

BACKGROUND: ParticipACTION's Think Again campaign targeted mothers who think their children are sufficiently active, yet whose children do not achieve recommended amounts of physical activity. PURPOSE: This research examined the relationship of mothers' intentions to support children's physical activity with explicit believability and implicit agreement with the Think Again campaign message, attention paid to the advertisement, involvement with the issue, concern regarding children's inactivity, and attitudes. METHOD: Participants were mothers from Edmonton, Canada (N = 102) who viewed one Think Again advertisement then completed a measure of implicit agreement with the campaign message and questionnaires. RESULTS: The mothers who paid attention to the message and were concerned for their own children were more likely to intend to act on campaign messages. The majority of participants implicitly agreed that children's physical inactivity was a problem, but there was less agreement that physical inactivity was a problem for their own children. CONCLUSION: Participants automatically tended to agree with campaign messages when the focus was on children in general, but there was greater disagreement when asked about participant's own children. Why most mothers were not in agreement with the reality of how much physical activity their children needs remains to be determined.

Narratives of athletic identity after acquiring a permanent physical disability.

Individuals with acquired physical disabilities report lower levels of athletic identity. The objective of this study was to further explore why athletic identity may be lost or (re)developed after acquiring a physical disability. Seven women and four men (range = 28-60 years) participated in approximately 1-hour-long semistructured interviews; data were subjected to a narrative analysis. The structural analysis revealed three narrative types. The nonathlete narrative described physical changes in the body as reasons for diminished athletic identity. The athlete as a future self primarily focused on present sport behavior and performance goals such that behavior changes diminished athletic identity. The present self as athlete narrative type focused on the aspects of their present sport involvement, such as feedback from other athletes and skill development, which supported their athletic identity. Implications of these narrative types with respect to sport promotion among people with acquired physical disabilities are discussed.

Testing messages to encourage discussion of clinical trials among cancer survivors and their physicians: examining monitoring style and message detail.

Encouraging cancer survivors to discuss clinical trials with their physicians may increase enrollment in clinical trials. Health messages offer one method for encouraging such discussions. We hypothesized that matching messages to an individual's preference for detailed or non-detailed information (i.e., monitoring style) would result in more discussions. Participants (N = 538) were cancer survivors, who phoned the National Cancer Institute's Cancer Information Service (CIS). Participants were classified as higher or lower monitors and then randomized to receive detailed or non-detailed messages in the mail 1 and 4 weeks following their baseline CIS call. At 12 weeks, there was a significant interaction between monitoring style and message detail. Follow-up analyses were nonsignificant but suggested a theoretically consistent pattern in which non-detailed messages were more effective among lower monitors. These findings imply that providing extremely detailed information may be excessive, even to individuals engaged in information seeking behavior.

Reliability and validity tests of the leisure time physical activity questionnaire for people with spinal cord injury.

OBJECTIVE: To examine the criterion validity and test-retest reliability of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI), a brief measure of leisure time physical activity (LTPA) for people with spinal cord injury (SCI). DESIGN: Survey with a 1-week follow-up. SETTING: General community. PARTICIPANTS: Men and women with SCI (N=103; mean age ± SD, 48.1±12.7 y; mean years postinjury ± SD, 17.9±11.9) who used a wheelchair as the primary mode of mobility. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed the Physical Activity Recall Assessment for People with SCI (PARA-SCI) and the LTPAQ-SCI. A subset of the participants (n=35) completed the LTPAQ-SCI a second time, 7 days later. RESULTS: Statistically significant, positive correlations emerged between the LTPAQ-SCI and PARA-SCI measures of mild, moderate, and heavy intensity LTPA as well as total LTPA. All 4 intraclass correlation coefficients were significant across the test-retest period. CONCLUSIONS: This study provides preliminary evidence of the criterion validity and reliability of the LTPAQ-SCI as a brief measure of LTPA performed by people with SCI.

Determinants of physical activity among people with spinal cord injury: a test of social cognitive theory.

BACKGROUND: Little theory-based research has focused on understanding and increasing physical activity among people with physical disabilities. Testing a social cognitive theory-based model of determinants is important for identifying variables to target in physical activity-enhancing interventions. PURPOSE: The aim of this study is to examine Social Cognitive Theory variables as predictors of physical activity among people living with spinal cord injury. METHODS: Structural equation modeling was used to test a model of Social Cognitive Theory predictors of physical activity (n=160). RESULTS: The model explained 39% of the variance in physical activity. Self-regulation was the only significant, direct predictor. Self-regulatory efficacy and outcome expectations had indirect effects, mediated by self-regulation. CONCLUSION: Social Cognitive Theory is useful for predicting physical activity in people with spinal cord injury. Self-regulation is the most potent Social Cognitive Theory predictor of physical activity in people with spinal cord injury. Self-regulation and its determinants should be targeted in physical activity-enhancing interventions.

Effects of a print-mediated intervention on physical activity during transition to the first year of university.

Transition to the first year of university is linked to steep declines in moderate-vigorous physical activity (MVPA). The purpose of this study was to investigate the effects of a targeted, theory-driven, print-based intervention on MVPA during transition to university. Volunteer participants from five Canadian universities (n=255) completed measures of MVPA at the start of their first semester at university and were randomly assigned to conditions receiving a first-year-student physical activity and action-planning brochure, Canada's Physical Activity Guide (CPAG), or a no-intervention control group. Six weeks later, a follow-up measure of MVPA was obtained as well as retrospective accounts of physical activity action-planning strategies and self-efficacy for scheduling physical activity. At the follow-up, students who received the targeted first-year student physical activity brochure reported significantly higher levels of MVPA compared to controls (p<.05) and a trend towards higher MVPA compared to the CPAG group (p=.06). However, there were no differences between groups on action planning or self-efficacy. A theory-driven and targeted print media intervention can offer low-cost and broad-reaching effects that may help students stay more active or curb declining levels of MVPA that occur during transition to university.

An investigation of the theoretical content of physical activity brochures.

New evidence-based physical activity guidelines and recommendations for constructing messages supplementing the guidelines have been put forth. As well, recent reviewshave identified theoretical constructs that hold promise as targets for intervention: self-regulation, outcome expectancies and self-efficacy. The purpose of this study was to examine the integration of messages targeting self-regulation, self-efficacy and outcome expectancies in existing physical activity brochures. Twenty-two PA brochures from Canadian and American National Health Organizations were assessed for their use self-efficacy, self-regulatory processes and outcome expectancies. Brochures were analyzed line-by-line using a modified version of the validated Content Analysis Approach to Theory-Specified Persuasive Educational Communication (CAATSPEC; Abraham et al., 2007). One third of the brochures were coded by two independent raters coded a third of the brochures (n = 7). Inter-rater reliability was acceptable for 17 of the 20 categories (rs> .79). Discrepancies in all categories were discussed and agreement was reached. The remaining brochures were coded by one of the two raters. Usage of thethree key theoretical constructs accounted for only 36.43% of brochure content (20.23% self-efficacy, 10.40% outcome expectancies, 5.80% self-regulation). Brochures lacked the use of a variety of theoretical strategies, specifically goal-setting, planning and verbal persuasion and rarely highlighted the affective benefits of physical activity. In the future brochures should aim to place increased emphasis on self-regulation, self-efficacy, and affective outcome expectancies.

Nicotine dependence as a moderator of message framing effects on smoking cessation outcomes.

BACKGROUND: The persuasiveness of gain-framed and loss-framed messages for smoking cessation may vary by smokers' characteristics. Preliminary research in non-treatment-seeking smokers has shown that level of nicotine dependence moderates the effects of framed smoking messages on quit intentions and smoking cessation attitudes. Nicotine dependence as a potential moderator of message framing effects on actual smoking outcomes among treatment-seeking smokers remains to be determined. PURPOSE: This secondary analysis of data from a smoking cessation trial (Psychol Addict Behav. 2007; 21: 534-544) examined nicotine dependence as a moderator of message framing effects on smoking cessation success. METHODS: Dependence scores were dichotomized into high and low dependence (n = 249). RESULTS: Among high-dependent smokers, gain-framed messages were associated with higher levels of smoking abstinence both during and post-treatment than loss-framed messages. There was no differential effect of gain- versus loss-framed messages among low-dependent smokers. CONCLUSION: These preliminary findings suggest that the effectiveness of message framing interventions for treatment-seeking smokers may vary by smokers' level of nicotine dependence.

A systematic review of three approaches for constructing physical activity messages: What messages work and what improvements are needed?

BACKGROUND: To motivate individuals to adhere to a regular physical activity regime, guidelines must be supplemented with persuasive messages that are disseminated widely. While substantial research has examined effective strategies for disseminating physical activity messages, there has been no systematic effort to examine optimal message content. This paper reviews studies that evaluate the effectiveness of three approaches for constructing physical activity messages including tailoring messages to suit individual characteristics of message recipients (message tailoring), framing messages in terms of gains versus losses (message framing), and targeting messages to affect change in self-efficacy (i.e., a theoretical determinant of behavior change). METHODS: We searched the MEDLINE, PsycINFO, EMBASE and CINAHL databases up to July 2008. Relevant reference lists also were searched. We included intervention trials, field experiments, and laboratory-based studies that aimed to test the efficacy or effectiveness of tailored messages, framed messages and self-efficacy change messages among healthy adults. We used a descriptive approach to analyze emerging patterns in research findings. Based on this evidence we made recommendations for practice and future research. RESULTS: Twenty-two studies were identified. Twelve studies evaluated message tailoring. In 10 of these studies, tailored messages resulted in greater physical activity than a control message. Six studies evaluated framed messages. Five of these studies demonstrated that gain-framed messages lead to stronger intentions to be active compared to a control message. Moreover, a gain-frame advantage was evident in three of the four studies that assessed physical activity. Four studies evaluated self-efficacy change messages. The two studies that used an experimental design provide a clear indication that individuals' beliefs can be affected by messages that incorporate types of information known to be determinants of self-efficacy. Overall, strong evidence to support definitive recommendations for optimal message content and structure was lacking. CONCLUSIONS: Additional research testing the optimal content of messages used to supplement physical activity guidelines is needed. Tailored messages, gain-framed messages, and self-efficacy change messages hold promise as strategies for constructing physical activity messages and should be a focus of future research.

Leisure time physical activity in a population-based sample of people with spinal cord injury part I: demographic and injury-related correlates.

OBJECTIVES: To estimate the number of minutes a day of leisure time physical activity (LTPA) performed by people with chronic spinal cord injury (SCI) and to identify the demographic and injury-related characteristics associated with LTPA in a population-based sample of people with chronic SCI. DESIGN: Cross-sectional telephone survey. SETTING: General community. PARTICIPANTS: Men and women with SCI (N=695). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The number of minutes/day of LTPA performed at a mild intensity or greater. RESULTS: Respondents reported mean minutes +/- SD of 27.14+/-49.36 of LTPA/d; however, 50% reported no LTPA whatsoever. In a multiple regression analysis, sex, age, years postinjury, injury severity, and primary mode of mobility each emerged as a unique predictor of LTPA. Multiple correspondence analysis indicated that being a man over the age of 34 years and greater than 11 years postinjury was associated with inactivity, while being a manual wheelchair user and having motor complete paraplegia were associated with the highest level of daily LTPA. CONCLUSIONS: Daily LTPA levels are generally low in people with SCI. Women, older adults, people with less recent injuries, people with more severe injuries, and users of power wheelchairs and gait aids are general subgroups that may require special attention and resources to overcome unique barriers to LTPA. Specific subgroups may also require targeted interventions.

Leisure time physical activity in a population-based sample of people with spinal cord injury part II: activity types, intensities, and durations.

OBJECTIVE: To describe the types, intensities, and average duration of leisure time physical activities (LTPAs) performed by people with chronic spinal cord injury (SCI). DESIGN: Cross-sectional telephone survey. SETTING: General community. PARTICIPANTS: Men and women with SCI (N=347) who reported engaging in LTPA over the previous 3 days. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mean minutes a day of LTPA performed at mild, moderate, and heavy intensities; proportion of respondents performing specific types of LTPA. RESULTS: Participants reported a mean +/- SD of 55.15+/-59.05min/d of LTPA at a mild intensity or greater. Median LTPA was 33.33min/d. More activity was done at a moderate intensity (mean +/- SD, 25.49+/-42.11min/d) than mild (mean +/- SD, 19.14+/-37.77min/d) or heavy intensities (mean +/- SD, 10.52+/-22.17min/d). Most participants reported mild (54%) or moderate intensity LTPA (68%), while a minority reported heavy intensity LTPA (43%). The 3 most frequently reported types of LTPA were resistance training (33%), aerobic exercise (25%), and wheeling (24%). Craftsmanship (mean +/- SD, 83.79+/-96.00min/d) and sports activities (mean +/- SD, 60.86+/-59.76 min/d) were performed for the longest durations. CONCLUSIONS: There is considerable variability in daily LTPA among active people with SCI and variability across different types of LTPA in terms of typical durations and intensities. This information can be used to help people with chronic SCI become more active by highlighting activities that meet individual abilities, needs, and desires.

The identification of framed messages in the New York State Smokers' Quitline materials.

Research suggests that smoking cessation messages are most persuasive when framed in terms of the benefits achieved from quitting (i.e. gain-framed) than when framed in terms of the costs of not quitting (i.e. loss-framed). It is unknown, however, if these findings about optimal message frames have been translated into public health practice. The current study examined message framing in telephone counseling sessions with smokers calling the New York State Smokers' Quitline (NYSSQ). We conducted a content analysis of all NYSSQ print material and 12 Quitline service calls. Two independent raters coded each message within these documents as being gain-framed, loss-framed or non-framed. Messages from the service calls also were coded for their function (e.g. information provision, information gathering). Interrater reliability was acceptable (kappa > 0.80). Of the 997 print messages evaluated, 21.6% were gain-framed, 13.8% were loss-framed and 64.6% were non-framed. For the service calls, only the messages with an information provision function included framed content. Of the 420 information provision messages, 10.2% were gain-framed, 1.7% were loss-framed and 88.1% were non-framed. The loss-framed and non-framed messages indicate missed opportunities for providing gain-framed messages within the Quitline services, thus emphasizing a possible gap between research and practice.

A Review of Acculturation Measures and Their Utility in Studies Promoting Latino Health.

The authors reviewed the acculturation literature with the goal of identifying measures used to assess acculturation in Hispanic populations in the context of studies of health knowledge, attitudes, and behavior change. Twenty-six acculturation measures were identified and summarized. As the Hispanic population continues to grow in the United States, there is a need to develop rigorous acculturation measures that include health indicators. Findings suggest that multidimensional acculturation scales are robust measurement tools when assessing nationality, cultural awareness, media and language preferences, and health status. Furthermore, aspects of Hispanic cultural lifestyle, such as beliefs about nutrition and physical activity, affect health care utilization, treatment, and prevention. Health communication researchers should consider aspects of cultural values and beliefs, and their impact on health status, for future research and health promotion interventions.

Increased participation in activities of daily living is associated with lower cholesterol levels in people with spinal cord injury.

UNLABELLED: Hetz SP, Latimer AE, Martin Ginis KA, Buchholz AC, and the SHAPE-SCI Research Group. Increased participation in activities of daily living is associated with lower cholesterol levels in people with spinal cord injury. OBJECTIVE: To evaluate the relationships between activities of daily living (ADLs) participation and coronary heart disease (CHD) risk factors in people with spinal cord injury. DESIGN: Cross-sectional. SETTING: Community, university, hospital. PARTICIPANTS: Participants (N=75) from the Study of Health and Activity in People With Spinal Cord Injury study (61 men, 14 women). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical Activity Recall Assessment for People With Spinal Cord Injury and CHD risk factor assessment including waist circumference, total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol, and triglycerides. RESULTS: Using generalized linear models, and controlling for leisure time physical activity and covariates, increased Mobility ADLs (transferring and wheeling) were associated with lower plasma total cholesterol and LDL. No other significant relationships emerged. CONCLUSIONS: Mobility ADLs were associated with lower total cholesterol and LDL. However, neither Total ADLs nor Domestic ADLs were associated with CHD risk. Further investigation is needed to determine causality between Mobility ADLs and CHD risk.

Promoting fruit and vegetable intake through messages tailored to individual differences in regulatory focus.

BACKGROUND: Researchers must identify strategies to optimize the persuasiveness of messages used in public education campaigns encouraging fruit and vegetable (FV) intake. PURPOSE: This study examined whether tailoring messages to individuals' regulatory focus (RF), the tendency to be motivated by promotion versus prevention goals, increased the persuasiveness of messages encouraging greater FV intake. METHOD: Participants (n = 518) completed an assessment of their RF and were randomly assigned to receive either prevention- or promotion-oriented messages. Messages were mailed 1 week, 2 months, and 3 months after the baseline interview. Follow-up assessments were conducted 1 and 4 months after the baseline assessment. RESULTS: Regression analyses revealed that at Month 4, the messages were somewhat more efficacious when congruent with participants' RF. CONCLUSION: RF may be a promising target for developing tailored messages promoting increased FV intake, and particularly for encouraging individuals to meet FV guidelines.

Promoting participation in physical activity using framed messages: an application of prospect theory.

OBJECTIVES: Messages designed to motivate participation in physical activity usually emphasize the benefits of physical activity (gain-framed) as well as the costs of inactivity (loss-framed). The framing implications of prospect theory suggest that the effectiveness of these messages could be enhanced by providing gain-framed information only. We compared the effectiveness of gain-, loss-, and mixed-framed messages for promoting moderate to vigorous physical activity. DESIGN: Randomized trial. METHOD: Sedentary, healthy callers to the US National Cancer Institute's Cancer Information Service (N=322) received gain-, loss-, or mixed-framed messages on three occasions (baseline, Week 1, and Week 5). Social cognitive variables and self-reported physical activity were assessed at baseline, Week 2, and Week 9. Separate regression analyses were conducted to examine message effects at each assessment point. RESULTS: At Week 2, gain- and mixed-framed messages resulted in stronger intentions and greater self-efficacy than loss-framed messages. At Week 9, gain-framed messages resulted in greater physical activity participation than loss- or mixed-framed messages. Social cognitive variables at Week 2 did not mediate the Week 9 framing effects on physical activity participation. CONCLUSIONS: Using gain-framed messages exclusively may be a means of increasing the efficacy of physical activity materials.

Comparing gain- and loss-framed messages for smoking cessation with sustained-release bupropion: a randomized controlled trial.

Prospect theory suggests that because smoking cessation is a prevention behavior with a fairly certain outcome, gain-framed messages will be more persuasive than loss-framed messages when attempting to encourage smoking cessation. To test this hypothesis, the authors randomly assigned participants (N=258) in a clinical trial to either a gain- or loss-framed condition, in which they received factually equivalent video and printed messages encouraging smoking cessation that emphasized either the benefits of quitting (gains) or the costs of continuing to smoke (losses), respectively. All participants received open label sustained-release bupropion (300 mg/day) for 7 weeks. In the intent-to-treat analysis, the difference between the experimental groups by either point prevalence or continuous abstinence was not statistically significant. Among 170 treatment completers, however, a significantly higher proportion of participants were continuously abstinent in the gain-framed condition as compared with the loss-framed condition. These data suggest that gain-framed messages may be more persuasive than loss-framed messages in promoting early success in smoking cessation for participants who are engaged in treatment.

Physical activity guides for Canadians: messaging strategies, realistic expectations for change, and evaluation.

Physical activity guidelines offer evidence-based behavioural benchmarks that relate to reduced risk of morbidity and mortality if people adhere to them. Essentially, the guidelines tell people what to do, but not why and how they should do it. Thus, to motivate adherence, messages that translate guidelines should convey not only how much physical activity one should attempt and why it is recommended, but also how to achieve such a recommendation. Canada's physical activity guides exemplify how guidelines can be translated. This paper (i) provides a brief overview of the challenges encountered in creating the existing guides and (ii) highlights important practical issues and empirical evidence that should be considered in the future when translating guidelines into messages and disseminating these messages. We draw on the successes of past efforts to translate the goals of physical activity guidelines and on recent literature on messages and media campaigns to make recommendations. Information to motivate people to move toward the goals in physical activity guidelines should be translated into a set of messages that are informative, thought provoking, and persuasive. These messages should be disseminated to the public via a multi-phase social-marketing campaign that is carefully planned and thoroughly evaluated.

Physical activity guidelines and guides for Canadians: facts and future.

This article summarizes the main findings from the papers included in this journal supplement. It consolidates the evidence currently available to inform and advance the development of physical activity guidelines for Canadians, and it highlights the specific needs of various population subgroups. The challenges of translating guideline information into effective and persuasive physical activity messages, of campaigns to disseminate messages, and of related evaluations are underlined. Recommendations on how to proceed are based on the evidence base provided by this series of papers; the immediate next steps mandated by this initiative are outlined and priorities for future research are indicated.

Weight training to activities of daily living: helping older adults make a connection.

PURPOSE: To compare a weight training alone treatment (WT) to an innovative WT plus education treatment (WT + ED) about the use of strength-training gains when performing activities of daily living (ADL) with respect to their effects on ADL self-efficacy and performance. METHODS: Twenty-three men and 41 women (mean age = 74.4 +/- 3.7 yr) were randomly assigned to WT or WT + ED. Both groups performed 12 wk (two sessions per week) of WT targeting eight major muscle groups. WT + ED received behavioral training and associated written materials emphasizing the link between WT and ADL. WT received a placebo educational intervention. Baseline and posttest measures were collected for self-efficacy for performing eight lab-based ADL tasks and performance of the eight ADL tasks. A manipulation check compared participants' knowledge of ADL that might be improved through WT. RESULTS: The WT + ED treatment listed more ADL that could be improved with WT and had greater posttest self-efficacy for performing the ADL lab tasks than the WT treatment. Greater ADL self-efficacy did not translate into better ADL performance. CONCLUSIONS: A targeted educational intervention can help older adults generalize the benefits and confidence obtained through WT to their performance of ADL. Further research is needed to determine the behavioral and psychosocial impact of enhanced ADL self-efficacy on older adults.